Cho Tracey A, Vaitkevicius Henrikas
MGH Neurology, 55 Fruit St, Boston, MA 02114, USA.
Continuum (Minneap Minn). 2012 Dec;18(6 Infectious Disease):1351-73. doi: 10.1212/01.CON.0000423851.63017.2a.
Infections and secondary inflammatory changes play an important role in spine pathology leading to myelopathy or myelitis. To achieve optimal clinical outcomes and accurate prognosis, physicians must promptly recognize these disorders. This review provides a contemporary overview of the major pathogens known to cause myelopathic symptoms and focuses on unique clinical syndromes and signs to aid the differential diagnosis and further workup. This article will help neurologists to consider infectious etiologies during the initial evaluation of patients with myelopathic symptoms.
The spectrum of neurologic infectious diseases is ever evolving because of immigration and travel, aggressive antibiotic use, vaccinations, and effective antiretroviral therapies. One example of this is illustrated by the enteroviruses. Poliovirus is an enterovirus that causes an acute flaccid paralysis but can be prevented by vaccination. A different enterovirus, enterovirus 71, is increasingly reported as the etiologic agent of acute flaccid paralysis similar in presentation to poliomyelitis. This review recognizes the shifting spectrum of infections in immunocompromised hosts, including patients with HIV in the era of effective antiretroviral therapy. It outlines unique features of primary HIV complications as well as closely associated infections, such as tuberculosis, syphilis, and varicella-zoster virus. Finally, each section of this article outlines molecular and immunologic tools that are becoming paramount for effective and rapid diagnosis of the pathogens.
This article offers a basic review and definitions pertinent to myelopathic processes. Parainfectious, viral, bacterial, parasitic, and fungal infections are discussed. Each section offers clinical descriptions, pathophysiologic mechanisms, diagnostic strategies, and an approach to treatment and prognosis. Clinical vignettes describe clinical presentations and imaging findings of prototype disorders leading to myelopathy.
感染及继发性炎症变化在导致脊髓病或脊髓炎的脊柱病理过程中起着重要作用。为实现最佳临床疗效及准确预后，医生必须及时识别这些疾病。本综述对已知可引起脊髓病症状的主要病原体进行了当代概述，并着重介绍独特的临床综合征和体征，以辅助鉴别诊断及进一步检查。本文将帮助神经科医生在对有脊髓病症状的患者进行初始评估时考虑感染性病因。
由于移民、旅行、积极使用抗生素、接种疫苗及有效的抗逆转录病毒疗法，神经感染性疾病谱不断演变。肠道病毒就是一个例子。脊髓灰质炎病毒是一种可导致急性弛缓性麻痹的肠道病毒，但可通过接种疫苗预防。另一种肠道病毒，肠道病毒71型，越来越多地被报道为急性弛缓性麻痹的病原体，其表现与脊髓灰质炎相似。本综述认识到免疫功能低下宿主（包括在有效抗逆转录病毒治疗时代的HIV患者）中感染谱的变化。它概述了原发性HIV并发症以及密切相关感染（如结核病、梅毒和水痘-带状疱疹病毒）的独特特征。最后，本文各部分概述了对病原体进行有效快速诊断变得至关重要的分子和免疫学工具。
本文提供了与脊髓病过程相关的基础综述及定义。讨论了感染后、病毒、细菌、寄生虫和真菌感染。各部分提供了临床描述、病理生理机制、诊断策略以及治疗和预后方法。临床案例描述了导致脊髓病的典型疾病的临床表现和影像学检查结果。
